Your Comprehensive Guide to Ocular Aesthetics

The aesthetic industry has been rapidly growing in recent years, with an increasing number of patients seeking out noninvasive procedures and techniques to address cosmetic concerns. In the United States, the medical aesthetic market is a multibillion-dollar industry.¹ The global noninvasive aesthetic treatment market size was valued at $61.2 billion USD in 2022 and is projected to expand at a compound annual growth rate of 15.40% from 2023 to 2030.²

Ocular aesthetics has emerged as a promising avenue for those seeking to diversify their services and distinguish their practices. To navigate the challenges posed by online eye wear, contact lens retailers, large retail chains, and low reimbursement vision plans, a growing number of optometrists are turning to cash-pay specialty care services. By adopting these services, we can mitigate the hassles associated with insurance, boost revenue, broaden our clinical expertise, and offer cutting-edge services that cater to our patients’ needs.

This article explores some important considerations to take into account if you’re debating whether to add ocular aesthetics to your clinic. This will include an overview of ocular aesthetics, common equipment, legal considerations, your aesthetics team, and more.

OCULAR AESTHETICS: AN OVERVIEW

Ocular aesthetics involves the use of cosmetic treatments to improve the appearance of the eyes and surrounding tissues. The spectrum of ocular aesthetics encompasses a variety of services, from basic skin care and makeup recommendations to advanced laser procedures, neurotoxins, and dermal fillers.

The integration of ocular aesthetics into the realm of optometry was significantly influenced by the approval of intense pulsed light (IPL) therapy for the treatment of dry eye. This integration marked a pivotal moment in the convergence of these two fields. Originally emerging from the field of aesthetics, IPL has steadily gained popularity and is now considered one of the most effective treatments for dry eye disease, particularly disease due to meibomian gland dysfunction (MGD). Initially created for cosmetic applications, IPL has undergone extensive research, proving its efficacy in addressing dry eye and subsequently earning its designation as a stage 2 treatment, according to the Tear Film & Ocular Surface Society Dry Eye Workshop II guidelines.³ By targeting abnormal vessels and melanin, IPL has demonstrated its ability to naturally enhance skin tone and appearance. Patients receiving IPL treatment for dry eye frequently observe a reduction or elimination of sun and age spots and improvements in facial and eyelid telangiectasia, such as in cases of rosacea and ocular rosacea.

Patients who receive IPL for dry eye and appreciate its aesthetic “side effects” often express interest in exploring other aesthetic treatments. Proactive optometrists can seize this opportunity by incorporating additional advanced OSD treatments that provide aesthetic benefits, along with treatments specifically developed for aesthetic purposes.

Ocular aesthetics goes far beyond merely performing treatments; it also involves educating patients on potentially harmful chemicals found in makeup and skin care formulas and their effects on eye health. The delicate tissues surrounding the eyes are particularly sensitive to harsh chemicals, and prolonged exposure to such chemicals can lead to inflammation, irritation, MGD, and damage to the ocular surface. It is up to us to inform patients about the risks associated with the use of these products and to offer alternative options that are “eye friendly.” Often, a simple change in skin care or makeup routine can have a significant effect on a patient’s symptoms and quality of life.

COMMON EQUIPMENT

Adding ocular aesthetics to a clinic requires an investment in equipment and supplies. Depending on the types of services you plan to offer, a range of devices and products to address skin tone, texture, and volume may be needed. Some of the most popular treatments for ocular aesthetics include IPL, radiofrequency (RF), low level light therapy (LLLT), RF microneedling, Hydrafacial (HydraFacial), OxyGeneo (Perfection Plastic Surgery and Skin Care), Plasma Pen (NuVissa), as well as injectable neurotoxins and dermal fillers.

IPL

In addition to dry eye treatment, IPL devices use intense pulses of light to address a variety of skin concerns, including pigmentation issues, rosacea, and broken capillaries. IPL devices can also be used to address dark circles and fine lines around the eyes. Not all IPL devices are created equally. Do your research before committing to a particular device.

RF

RF devices use energy waves to stimulate collagen production, which can improve the appearance of wrinkles, fine lines, and sagging skin. RF can also be used to address skin laxity and under eye bags. In recent years, RF has emerged as a promising modality for the treatment of MGD by delivering controlled heat to the periocular area and the meibomian glands. Through its mechanism of action (thermomodulation), RF can improve meibum flow and quality, helping to alleviate symptoms of dry eye.

LLLT

LLLT is a noninvasive, safe, and effective modality for promoting skin health by delivering specific wavelengths of light energy to targeted areas (thermobiomodulation), which penetrate deep into the skin to stimulate cellular function and promote healing. LLLT is used to reduce the appearance of fine lines and wrinkles, improve skin texture and tone, and reduce acne inflammation. For the eyes, LLLT has been shown to be effective in treating conditions, such as dry eye syndrome, MGD, and ocular rosacea.

RF Microneedling

Devices that combine microneedling with RF energy deliver deeper, more comprehensive skin rejuvenation. In addition to a tightening effect, RF microneedling can help reduce the appearance of wrinkles, scarring, and hyperpigmentation. It is also an option to address under eye bags.

One of the rooms dedicated to aesthetics in Dr. Swatts’ practice.

Hydrafacial

Hydrafacial is a noninvasive facial performed with a device rather than by hand, for deeper penetration and longer-lasting results. A wand works like a vacuum to open pores and extract impurities and dead skin cells. HydraFacial treatments are particularly effective for addressing fine lines, wrinkles, and other signs of aging around the eyes of patients.

OxyGeneo

This noninvasive, three-in-one treatment approach to rejuvenating the skin combines exfoliation, oxygenation, and infusion of active ingredients. OxyGeneo can help improve the appearance of fine lines, wrinkles, and dark circles.

Plasma Energy

Devices such as the NuVissa nSEL Plasma Pen use plasma energy to stimulate collagen production and tighten the skin. They can be particularly effective for addressing sagging skin around the eyes.

Toxins and Fillers

In addition to the aforementioned devices, optometrists who offer ocular aesthetic services may also wish to consider investing in neurotoxins. Some common toxins include onabotulinumtoxinA (Botox), abobotulinumtoxinA (Dysport, Galderma Laboratories), incobotulinumtoxinA (Xeomin, Merz Aesthetics), and prabotulinumtoxinA-xvfs injection (Jeuveau, Evolus), as well as dermal fillers, such as Juvaderm (AbbVie). These injectable products can effectively address fine lines, wrinkles, and other signs of aging around the eyes, while also providing the ability to enhance facial features, such as the eyes, lips, and cheeks.

AESTHETIC TEAM AND LEGAL CONSIDERATIONS

Optometrists who offer ocular aesthetics must be aware of the legal considerations and regulations surrounding these procedures. Each state has its own set of regulations, so it’s important to understand the rules and regulations pertaining to your state, and check with your state board, to ensure that you comply. Additionally, it’s crucial to make sure that your malpractice insurance covers any potential risks associated with ocular aesthetics services.

In some states, the scope of practice for optometrists can extend to specific aesthetic procedures, contingent on the requisite supervision and collaborative relationships with other health care professionals, such as physician assistants and nurse practitioners.

The role of a medical director (typically an MD) becomes pivotal in optometry practices that offer advanced aesthetic services. They supervise the medical components of the practice, providing direction and oversight to other health care professionals. Physician assistants and nurse practitioners can be valuable members of the aesthetic team, performing procedures often beyond the optometrist’s scope of practice.

Aestheticians can be a valuable addition to optometry practices, offering their expertise in skin care and assisting patients in achieving the best possible results from aesthetic procedures. It should be noted, however, that the scope of their practice and the procedures they are permitted to perform can also differ from state to state.

The American MedSpa Association (www.americanmedspa.org/) is an excellent resource for state-specific requirements and guidelines. This database will clarify who is legally permitted to perform aesthetics procedures in your state, which procedures they may perform, and whether a medical director is needed.

ADDITIONAL CONSIDERATIONS

There are many other factors to consider before adding ocular aesthetics to your practice.

Cash Pay Treatments

Optometrists who want to offer advanced dry eye and aesthetic treatments may initially hesitate to do so because of the unique challenges associated with offering cash-pay services. Overcoming this hesitation can be achieved through proper training and techniques. However, one of the main obstacles optometrists may encounter is convincing patients to move beyond the “insurance covers everything” mindset. Despite this challenge, the potential benefits of offering life-changing treatments and achieving remarkable outcomes, as well as the opportunity for revenue growth and patient retention, make the effort worthwhile.

Confidence

With the addition of advanced dry eye and aesthetic services comes ongoing training (not only for the doctor, but also for the entire team). Although ODs know facial anatomy, many have not studied skin in depth enough to jump right into aesthetics. Aesthetic devices are powerful and there is a risk of adverse events. Incorporating aesthetics means learning details of skin pathology, becoming familiar with skin care and makeup lines, and being comfortable and confident to discuss a patient’s appearance.

Belief in Technology

The aesthetics industry moves quickly, and sales tactics can be more aggressive than those commonly used in the ophthalmic world. Moreover, there are a plethora of devices to choose from, many of which optometrists are unfamiliar with. Determining which devices to invest in and whether they will deliver the desired outcomes can be challenging—especially considering the fact that uncertainty in your device can lead to a lack of confidence and may result in the device being underused or failing to provide a return on investment. Therefore, when considering a device with aesthetic capabilities, it’s important to ask critical questions. For example, is the device FDA-approved, and what is it specifically approved for? Are there established, approved protocols that have supporting studies? Does the device company invest in ongoing research? What type of maintenance is required, and are there ongoing fees? Are there consumable fees?

By addressing these questions and carefully evaluating the available options, optometrists can feel more confident in their technology investments, ultimately providing the best possible outcomes for their patients.

Team Support

The right team and appropriate training are crucial when offering ocular aesthetic services. Optometrists should ensure they have the appropriate health care professionals and aestheticians on staff to provide support and expertise. This includes understanding your state regulations surrounding who is allowed to perform certain procedures and what type of training is necessary. Optometrists should also be prepared to invest in the necessary equipment and supplies to provide these services.

A DECISION NOT TO BE MADE IN HASTE

Adding ocular aesthetic services to a practice can be a great opportunity for growth and differentiation, but it requires careful consideration. Optometrists must have the confidence and skills to perform these procedures safely, believe in the technology and its benefits, consider potential crossover opportunities with other services, and have the right team in place to support these services.

By taking the time to consider the factors described above, optometrists can make an informed decision about whether ocular aesthetics is right for their clinic.